Basic Information
| Provider Information | |||||||||
| NPI: | 1609872977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURGER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 5900 LAKE WRIGHT DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235021871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572135700 | ||||||||
| FaxNumber: | 7572135701 | ||||||||
| Practice Location | |||||||||
| Address1: | 5900 LAKE WRIGHT DR | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235021871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574668683 | ||||||||
| FaxNumber: | 7574668892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2005 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 0101018553 | VA | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 15140 | 01 | VA | OPTIMA | OTHER |